Registered Nurse Clinical Auditor
Registered Nurse Clinical Auditor <\/span><\/span><\/b><\/span><\/span><\/b> We are seeking a detail\-oriented Registered Nurse<\/b> to\nsupport medical record reviews, billing compliance audits for the Indiana\nHealth Coverage Programs. This role is responsible for evaluating the quality of care, reviewing medical records and program policies and identifying compliance\nissues, preparing audit documentation and reports, and supporting appeals\nactivities. The ideal candidate brings clinical knowledge, regulatory\nawareness, and strong analytical and writing skills. This is a remote position\nwith occasional travel required within Indiana. · <\/span><\/span><\/span><\/span><\/span>Review\nmedical records and related documentation to evaluate provider compliance with\nIndiana Health Coverage Programs, CMS, AMA, and other applicable standards and\nregulations.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Conduct\nmedical record and compliance reviews independently and provide preliminary\nfindings to the Lead Reviewer.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Identify\npotential documentation deficiencies, and billing compliance issues.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Maintain\ndetailed workpapers documenting procedures performed, records reviewed,\nfindings identified, and conclusions reached.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Assist\nwith audit responses and appeals as needed.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Ensure\nall work aligns with state, federal, and national healthcare and Medicaid guidelines.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Stay\ncurrent on clinical guidelines, policies, regulations, and Indiana Medicaid program\nand policy updates.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Research\nIndiana Medicaid rules and maintain internal repositories of bulletins,\npolicies, and procedures.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Adapt\nquickly to changing priorities, policies, regulatory updates, and review\nrequirements while maintaining accuracy and meeting deadlines.<\/span><\/span> Qualifications<\/span><\/span><\/b> · <\/span><\/span><\/span><\/span><\/span>RN\nlicense preferred; Indiana license or compact license accepted.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Coding\ncertification such as CCS or CPC strongly preferred.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Candidate\nlocated in or near the Indianapolis area is preferred.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>At\nleast 1 year of Medicaid claims review, billing compliance, or healthcare\nreimbursement experience.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Familiarity\nwith Indiana Medicaid policies, payer guidelines, and documentation\nrequirements preferred.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Knowledge\nof CPT coding guidelines and ICD\-10 standards.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Proficiency\nin Microsoft Excel, Word, and Outlook.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Strong\nanalytical, critical thinking, problem\-solving, and technical writing skills.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Ability\nto work independently and collaboratively in a fast\-paced environment.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Experience\nworking with healthcare providers is strongly preferred.<\/span><\/span> · <\/span><\/span><\/span><\/span><\/span>Knowledge\nof healthcare claims data and fraud, waste, and abuse preferred.<\/span><\/span>
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Key Responsibilities<\/span><\/span><\/b><\/span><\/span>
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<\/div><\/span>Requirements<\/h3>
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